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General NPI Number Information
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NPI Number | 1720552771
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Entity Type | Individual
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Provider Name | JOEL GEORGE SAJAN
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Gender | Male
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 6500 S MACARTHUR BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73169-6918
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Country | US
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Telephone | 405-954-1780
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Fax |
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Provider Business Mailing Address
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Address Line | 3224 S BROADWAY STE 112
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City | EDMOND
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State | OK
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Zip | 73013-4069
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA060597
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License Number State | PA
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